<?=$this->load->view('include_header',null)?>
<style type="text/css">
form#form textarea {
    height: 80px;
    overflow: auto;
    padding: 5px;
    width: 420px;
}
</style>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
		</div>
	</div>
	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  enctype="multipart/form-data" action="<?=site_url('schengen/au_tourism_update/'.$cateid)?>">

	<h3>澳大利亚旅游探亲申请表[48R]</h3>
    <table width="100%">
    <thead>
        <tr>
          <td colspan="3" align="right"><img src="<?= (@$info->avatar)?@$info->avatar:'images/avatar.gif'?>" width="150" height="150" /></td>
		  <td colspan="2" align="right">
		  上传照片<br />
		  <input type="file" name="userphoto"/><br />
		  (.gif|.jpg|.png文件,最大1M)<br />
		  <?php if (@$info->attachment):?><a href="<?= @$info->attachment?>" target="_blank">点击下载附件</a><?php endif; ?>
		  &nbsp;&nbsp;&nbsp;&nbsp;上传附件<br />
		  <input type="file" name="userfile"/><br />
		  (.pdf|.zip|.rar|.doc,最大2M)		  </td>
        </tr>
    </thead>
    <tfoot>
        <tr>
            <td colspan="5" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />			</td>
        </tr>
    </tfoot>

    <tbody>
		<tr class="odd">
            <td colspan="5">1 When do you wish to visit Australia?</td>
        	</tr>
        <tr class="even">
			<td>&nbsp;</td>
            <td>From(dd-mm-yyyy)</td>
        	<td nowrap="nowrap"><input type="text" name="visit_from" id="visit_from" value="<?= @$info->visit_from?>"/></td>
        	<td><p>To(dd-mm-yyyy)</p>        		</td>
        	<td nowrap="nowrap"><input type="text" name="visit_to" id="visit_to" value="<?= @$info->visit_to?>"/></td>		
        </tr>
		<tr class="odd">
            <td colspan="5">2 How long do you wish to stay in Australia?</td>
        </tr>
        <tr class="even">
			<td>&nbsp;</td>
            <td colspan="4">
			<input type="radio" name="visit_stay" value="1" <?= (@$info->visit_stay==1)?'checked':''?> />Up to 3 months 
        	<input type="radio" name="visit_stay" value="2" <?= (@$info->visit_stay==2)?'checked':''?> />Up to 6 months
			<input type="radio" name="visit_stay" value="3" <?= (@$info->visit_stay==3)?'checked':''?> />Up to 12 months			</td>
        </tr>
		<tr class="odd">
            <td colspan="5">3 Do you intend to enter Australia on more than one occasion?</td>
        	</tr>
        <tr class="even">
			<td>&nbsp;</td>
            <td>
			<input type="radio" name="is_more_enter" value="0" <?= (@$info->is_more_enter==0)?'checked':''?> />No 
        	<input type="radio" name="is_more_enter" value="1" <?= (@$info->is_more_enter==1)?'checked':''?> />Yes			</td>
        	<td colspan="3">Give details<input type="text" name="more_enter" value="<?= @$info->more_enter?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part A – Your details</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">4 Name(s) as shown in your passport</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Family name</td>
        	<td><input type="text" name="surname" value="<?= @$info->surname?>"/></td>
        	<td>Given names</td>
			<td><input type="text" name="firstname" value="<?= @$info->firstname?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Other names you are, or have been, known by	(including name at birth, previous married names, aliases)</td>
        	<td><textarea name="other_name" style="width:110px; height:40px"><?= @$info->given_name?></textarea></td>
        	<td>Name in your own language or script (if applicable)</td>
			<td><input type="text" name="own_language" value="<?= @$info->own_language?>"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">5 Sex</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="sex" value="1" <?= (@$info->sex==1)?'checked':''?> />Male 
        	<input type="radio" name="sex" value="2" <?= (@$info->sex==2)?'checked':''?> />Female</td>
        	</tr>
        <tr class="even">
            <td colspan="5">6 
            	Date of birth (DAY MONTH YEAR) 
            	<input type="text" name="birth" id="birth" value="<?= @$info->birth?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">7 Relationship status</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="marital_status" value="1" <?= (@$info->marital_status==1)?'checked':''?> />Married
        	<input type="radio" name="marital_status" value="2" <?= (@$info->marital_status==2)?'checked':''?> />Engaged
			<input type="radio" name="marital_status" value="3" <?= (@$info->marital_status==3)?'checked':''?> />De facto
			<input type="radio" name="marital_status" value="4" <?= (@$info->marital_status==4)?'checked':''?> />Separated
			<input type="radio" name="marital_status" value="5" <?= (@$info->marital_status==5)?'checked':''?> />Divorced
			<input type="radio" name="marital_status" value="6" <?= (@$info->marital_status==6)?'checked':''?> />Widowed
			<input type="radio" name="marital_status" value="7" <?= (@$info->marital_status==7)?'checked':''?> />Never married or been in a de facto relationship			</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">8 Place of birth</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Town/city</td>
        	<td><input type="text" name="birth_place" value="<?= @$info->birth_place?>"/></td>
        	<td>Country</td>
			<td><input type="text" name="birth_country" value="<?= @$info->birth_country?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">9 Details from your passport</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Passport number</td>
        	<td><input type="text" name="passport_no" value="<?= @$info->passport_no?>"/></td>
        	<td>Country of passport</td>
			<td><input type="text" name="passport_country" value="<?= @$info->passport_country?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Date of issue</td>
        	<td><input type="text" name="passport_issue" value="<?= @$info->passport_issue?>"/></td>
        	<td>Date of expiry</td>
			<td><input type="text" name="passport_expiry" value="<?= @$info->passport_expiry?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Issuing authority/Place of issue as shown in your passport</td>
        	<td><input type="text" name="passport_issue_by" value="<?= @$info->passport_issue_by?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">10 Details of identity card or identity number issued to you by your
            	government (if applicable) eg. National identity card.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Identity number</td>
        	<td><input type="text" name="national_id" value="<?= @$info->national_id?>"/></td>
        	<td>Country of issue</td>
			<td><input type="text" name="issuing_by" value="<?= @$info->issuing_by?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="2">11 Of which countries are you a citizen?</td>
        	<td><input type="text" name="citizen" value="<?= @$info->citizen?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="2">12 Country of usual residence</td>
        	<td><input type="text" name="residence_country" value="<?= @$info->residence_country?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">13 Your current residential address<br />
            	Note: A post office box address is not acceptable as a residential
            	address. Failure to give your residential address will result in this
            	application being invalid.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2"><textarea name="residential_address" style="width:220px; height:40px"><?= @$info->residential_address?>
        	</textarea></td>
        	<td>POSTCODE</td>
			<td><input type="text" name="residential_postcode" value="<?= @$info->residential_postcode?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">14 Postal address<br />
            	(If the same as your residential address, write ‘AS ABOVE’)</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2"><textarea name="postal_address" style="width:220px; height:40px"><?= @$info->postal_address?>
        	</textarea></td>
        	<td>POSTCODE</td>
			<td><input type="text" name="postal_postcode" value="<?= @$info->postal_postcode?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">15 Your telephone numbers</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>COUNTRY CODE</td>
        	<td>AREA CODE</td>
			<td>NUMBER</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Office hours</td>
        	<td><input type="text" name="tel1_country" value="<?= @$info->tel1_country?>"/></td>
        	<td><input type="text" name="tel1_area" value="<?= @$info->tel1_area?>"/></td>
			<td><input type="text" name="tel1_no" value="<?= @$info->tel1_no?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>After hours or
        		mobile/cell</td>
        	<td><input type="text" name="tel2_country" value="<?= @$info->tel2_country?>"/></td>
        	<td><input type="text" name="tel2_area" value="<?= @$info->tel2_area?>"/></td>
			<td><input type="text" name="tel2_no" value="<?= @$info->tel2_no?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">16 Do you agree to the department communicating with you by fax,e-mail or other electronic means?</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>
			<input type="radio" name="is_agress_contact" value="0" <?= (@$info->is_agress_contact==0)?'checked':''?> />No 
        	<input type="radio" name="is_agress_contact" value="1" <?= (@$info->is_agress_contact==1)?'checked':''?> />Yes			</td>
        	<td>Give details</td>
        	<td colspan="2">Fax number
				<input type="text" name="fax_country" value="<?= @$info->fax_country?>" style="width:30px"/>
				<input type="text" name="fax_area" value="<?= @$info->fax_area?>" style="width:30px"/>
				<input type="text" name="fax_no" value="<?= @$info->fax_no?>"/>			</td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td colspan="2">E-mail address
        		<input type="text" name="email" value="<?= @$info->email?>" id="email"/></td>
			</tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part B – Children included</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">17 Are there any children included in your passport who will be travelling with you?</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>
			<input type="radio" name="has_child_with" value="0" <?= (@$info->has_child_with==0)?'checked':''?> />No 
        	<input type="radio" name="has_child_with" value="1" <?= (@$info->has_child_with==1)?'checked':''?> />
        	Yes Give details</td>
        	<td>1</td>
        	<td>Family name</td>
			<td><input type="text" name="child1_family_name" value="<?= @$info->child1_family_name?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Given names</td>
			<td><input type="text" name="child1_given_name" value="<?= @$info->child1_given_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Sex</td>
			<td>
			<input type="radio" name="child1_sex" value="1" <?= (@$info->child1_sex==1)?'checked':''?> />Male 
        	<input type="radio" name="child1_sex" value="2" <?= (@$info->child1_sex==2)?'checked':''?> />Female			</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date of birth(d-m-y)</td>
			<td><input type="text" name="child1_birth" id="child1_birth" value="<?= @$info->child1_birth?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country of birth</td>
			<td><input type="text" name="child1_country" value="<?= @$info->child1_country?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>2</td>
        	<td class="odd">Family name</td>
        	<td class="odd"><input type="text" name="child2_family_name" value="<?= @$info->child2_family_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Given names</td>
        	<td class="even"><input type="text" name="child2_given_name" value="<?= @$info->child2_given_name?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Sex</td>
        	<td class="odd"><input type="radio" name="child2_sex" value="1" <?= (@$info->child2_sex==1)?'checked':''?> />
        		Male
        		<input type="radio" name="child2_sex" value="2" <?= (@$info->child2_sex==2)?'checked':''?> />
        		Female </td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Date of birth(d-m-y)</td>
        	<td class="even"><input type="text" name="child2_birth" id="child2_birth" value="<?= @$info->child2_birth?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Country of birth</td>
        	<td class="odd"><input type="text" name="child2_country" value="<?= @$info->child2_country?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>3</td>
        	<td>Family name</td>
        	<td><input type="text" name="child3_family_name" value="<?= @$info->child3_family_name?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Given names</td>
        	<td><input type="text" name="child3_given_name" value="<?= @$info->child3_given_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Sex</td>
        	<td><input type="radio" name="child3_sex" value="1" <?= (@$info->child3_sex==1)?'checked':''?> />
        		Male
        		<input type="radio" name="child3_sex" value="2" <?= (@$info->child3_sex==2)?'checked':''?> />
        		Female </td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date of birth(d-m-y)</td>
        	<td><input type="text" name="child3_birth" id="child3_birth" value="<?= @$info->child3_birth?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country of birth</td>
        	<td><input type="text" name="child3_country" value="<?= @$info->child3_country?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>4</td>
        	<td class="odd">Family name</td>
        	<td class="odd"><input type="text" name="child4_family_name" value="<?= @$info->child4_family_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Given names</td>
        	<td class="even"><input type="text" name="child4_given_name" value="<?= @$info->child4_given_name?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Sex</td>
        	<td class="odd"><input type="radio" name="child4_sex" value="1" <?= (@$info->child4_sex==1)?'checked':''?> />
        		Male
        		<input type="radio" name="child4_sex" value="2" <?= (@$info->child4_sex==2)?'checked':''?> />
        		Female </td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Date of birth(d-m-y)</td>
        	<td class="even"><input type="text" name="child4_birth" id="child4_birth" value="<?= @$info->child4_birth?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Country of birth</td>
        	<td class="odd"><input type="text" name="child4_country" value="<?= @$info->child4_country?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part C – Family NOT travelling with you</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">18 Do you have a spouse, de facto partner, any children, or fiancé who will NOT be travelling with you?</td>
        	</tr>
        <tr class="even">
            <td nowrap="nowrap">
			<input type="radio" name="has_no_with" value="0" <?= (@$info->has_no_with==0)?'checked':''?> />No 
        	<input type="radio" name="has_no_with" value="1" <?= (@$info->has_no_with==1)?'checked':''?> />Yes Give details			</td>
        	<td>Full name</td>
        	<td>Relationship to you</td>
        	<td>Date of birth
        		<hr />
        		DAY MONTH YEAR</td>
			<td>Their address while you are in Australia</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="spouse1_name" value="<?= @$info->spouse1_name?>"/></td>
        	<td><input type="text" name="spouse1_relate" value="<?= @$info->spouse1_relate?>"/></td>
        	<td nowrap="nowrap"><input type="text" name="spouse1_birth" id="spouse1_birth" value="<?= @$info->spouse1_birth?>"/></td>
			<td><input type="text" name="spouse1_address" value="<?= @$info->spouse1_address?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="spouse2_name" value="<?= @$info->spouse2_name?>"/></td>
        	<td><input type="text" name="spouse2_relate" value="<?= @$info->spouse2_relate?>"/></td>
        	<td><input type="text" name="spouse2_birth" id="spouse2_birth" value="<?= @$info->spouse2_birth?>"/></td>
			<td><input type="text" name="spouse2_address" value="<?= @$info->spouse2_address?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="spouse3_name" value="<?= @$info->spouse3_name?>"/></td>
        	<td><input type="text" name="spouse3_relate" value="<?= @$info->spouse3_relate?>"/></td>
        	<td><input type="text" name="spouse3_birth" id="spouse3_birth" value="<?= @$info->spouse3_birth?>"/></td>
			<td><input type="text" name="spouse3_address" value="<?= @$info->spouse3_address?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="spouse4_name" value="<?= @$info->spouse4_name?>"/></td>
        	<td><input type="text" name="spouse4_relate" value="<?= @$info->spouse4_relate?>"/></td>
        	<td><input type="text" name="spouse4_birth" id="spouse4_birth" value="<?= @$info->spouse4_birth?>"/></td>
			<td><input type="text" name="spouse4_address" value="<?= @$info->spouse4_address?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part D – Details of your visit to Australia</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">19 Is it likely you will be travelling from Australia to a neighbouring country
            	(eg. New Zealand, Singapore, Papua New Guinea) and back to Australia?</td>
        	</tr>
        <tr class="even">
            <td colspan="5">
			<input type="radio" name="is_to_neighbor" value="0" <?= (@$info->is_to_neighbor==0)?'checked':''?> />No 
        	<input type="radio" name="is_to_neighbor" value="1" <?= (@$info->is_to_neighbor==1)?'checked':''?> />Yes Please attach itinerary details</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">20 Do you have any relatives in Australia?</td>
        	</tr>
        <tr class="even">
            <td colspan="5">
			<input type="radio" name="has_relatives" value="0" <?= (@$info->has_relatives==0)?'checked':''?> />No 
        	<input type="radio" name="has_relatives" value="1" <?= (@$info->has_relatives==1)?'checked':''?> />Yes Give details			</td>
        	</tr>
		<tr class="odd">
            <td>Full name</td>
        	<td>Relationship to you</td>
        	<td>Date of birth
        		<hr />
        		DAY MONTH YEAR</td>
        	<td>Address</td>
			<td>Citizen or permanent resident of Australia?<br />(YES or NO)</td>
        </tr>
        <tr class="even">
            <td><input type="text" name="relatives1_name" value="<?= @$info->relatives1_name?>"/></td>
        	<td><input type="text" name="relatives1_relate" value="<?= @$info->relatives1_relate?>"/></td>
        	<td><input type="text" name="relatives1_birth" id="relatives1_birth" value="<?= @$info->relatives1_birth?>"/></td>
        	<td><input type="text" name="relatives1_address" value="<?= @$info->relatives1_address?>"/></td>
			<td>
			<input type="radio" name="relatives1_citizen" value="NO" <?= (@$info->relatives1_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="relatives1_citizen" value="YES" <?= (@$info->relatives1_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td><input type="text" name="relatives2_name" value="<?= @$info->relatives2_name?>"/></td>
        	<td><input type="text" name="relatives2_relate" value="<?= @$info->relatives2_relate?>"/></td>
        	<td><input type="text" name="relatives2_birth" id="relatives2_birth" value="<?= @$info->relatives2_birth?>"/></td>
        	<td><input type="text" name="relatives2_address" value="<?= @$info->relatives2_address?>"/></td>
			<td>
			<input type="radio" name="relatives2_citizen" value="NO" <?= (@$info->relatives2_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="relatives2_citizen" value="YES" <?= (@$info->relatives2_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td><input type="text" name="relatives3_name" value="<?= @$info->relatives3_name?>"/></td>
        	<td><input type="text" name="relatives3_relate" value="<?= @$info->relatives3_relate?>"/></td>
        	<td><input type="text" name="relatives3_birth" id="relatives3_birth" value="<?= @$info->relatives3_birth?>"/></td>
        	<td><input type="text" name="relatives3_address" value="<?= @$info->relatives3_address?>"/></td>
			<td>
			<input type="radio" name="relatives3_citizen" value="NO" <?= (@$info->relatives3_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="relatives3_citizen" value="YES" <?= (@$info->relatives3_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td><input type="text" name="relatives4_name" value="<?= @$info->relatives4_name?>"/></td>
        	<td><input type="text" name="relatives4_relate" value="<?= @$info->relatives4_relate?>"/></td>
        	<td><input type="text" name="relatives4_birth" id="relatives4_birth" value="<?= @$info->relatives4_birth?>"/></td>
        	<td><input type="text" name="relatives4_address" value="<?= @$info->relatives4_address?>"/></td>
			<td>
			<input type="radio" name="relatives4_citizen" value="NO" <?= (@$info->relatives4_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="relatives4_citizen" value="YES" <?= (@$info->relatives4_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="5">21 Do you have any friends or contacts in Australia?</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">
			<input type="radio" name="has_friend" value="0" <?= (@$info->has_friend==0)?'checked':''?> />No 
        	<input type="radio" name="has_friend" value="1" <?= (@$info->has_friend==1)?'checked':''?> />Yes Give details</td>
        	</tr>
        <tr class="even">
            <td>Full name</td>
        	<td>Relationship to you</td>
        	<td>Date of birth
        		<hr />
        		DAY MONTH YEAR</td>
        	<td>Address</td>
			<td>Citizen or permanent resident of Australia?<br />(YES or NO)</td>
        </tr>
		<tr class="odd">
            <td><input type="text" name="friend1_name" value="<?= @$info->friend1_name?>"/></td>
        	<td><input type="text" name="friend1_relate" value="<?= @$info->friend1_relate?>"/></td>
        	<td><input type="text" name="friend1_birth" id="friend1_birth" value="<?= @$info->friend1_birth?>"/></td>
        	<td><input type="text" name="friend1_address" value="<?= @$info->friend1_address?>"/></td>
			<td>
			<input type="radio" name="friend1_citizen" value="NO" <?= (@$info->friend1_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="friend1_citizen" value="YES" <?= (@$info->friend1_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td><input type="text" name="friend2_name" value="<?= @$info->friend2_name?>"/></td>
        	<td><input type="text" name="friend2_relate" value="<?= @$info->friend2_relate?>"/></td>
        	<td><input type="text" name="friend2_birth" id="friend2_birth" value="<?= @$info->friend2_birth?>"/></td>
        	<td><input type="text" name="friend2_address" value="<?= @$info->friend2_address?>"/></td>
			<td>
			<input type="radio" name="friend2_citizen" value="NO" <?= (@$info->friend2_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="friend2_citizen" value="YES" <?= (@$info->friend2_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td><input type="text" name="friend3_name" value="<?= @$info->friend3_name?>"/></td>
        	<td><input type="text" name="friend3_relate" value="<?= @$info->friend3_relate?>"/></td>
        	<td><input type="text" name="friend3_birth" id="friend3_birth" value="<?= @$info->friend3_birth?>"/></td>
        	<td><input type="text" name="friend3_address" value="<?= @$info->friend3_address?>"/></td>
			<td>
			<input type="radio" name="friend3_citizen" value="NO" <?= (@$info->friend3_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="friend3_citizen" value="YES" <?= (@$info->friend3_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td><input type="text" name="friend4_name" value="<?= @$info->friend4_name?>"/></td>
        	<td><input type="text" name="friend4_relate" value="<?= @$info->friend4_relate?>"/></td>
        	<td><input type="text" name="friend4_birth" id="friend4_birth" value="<?= @$info->friend4_birth?>"/></td>
        	<td><input type="text" name="friend4_address" value="<?= @$info->friend4_address?>"/></td>
			<td>
			<input type="radio" name="friend4_citizen" value="NO" <?= (@$info->friend4_citizen=='NO')?'checked':''?> />No 
        	<input type="radio" name="friend4_citizen" value="YES" <?= (@$info->friend4_citizen=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="5">22 Why do you want to visit Australia?
            	Include details of any dates that are
            	of special significance to your visit.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="4"><textarea name="visit_reason"><?= @$info->visit_reason?></textarea></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">23 Do you intend to do a course of study while in Australia?</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="radio" name="has_course" value="0" <?= (@$info->has_course==0)?'checked':''?> />No 
        	<input type="radio" name="has_course" value="1" <?= (@$info->has_course==1)?'checked':''?> />Yes Give details</td>
        	<td>Name of the course</td>
        	<td><input type="text" name="course_name" value="<?= @$info->course_name?>"/></td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Name of the institution</td>
        	<td><input type="text" name="course_institution" value="<?= @$info->course_institution?>"/></td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>How long will the course last?</td>
        	<td><input type="text" name="course_long" value="<?= @$info->course_long?>"/></td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part E – Health and character</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">24 In the last 5 years, have you, or any other person included in this application, visited or lived outside your country of passport for more than 3 consecutive months?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_outside" value="0" <?= (@$info->has_outside==0)?'checked':''?> />No 
        	<input type="radio" name="has_outside" value="1" <?= (@$info->has_outside==1)?'checked':''?> />Yes Give details</td>
        	<td>1</td>
        	<td>Name</td>
        	<td colspan="2"><input type="text" name="outside1_name" value="<?= @$info->outside1_name?>"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country(s)</td>
        	<td colspan="2"><input type="text" name="outside1_country" value="<?= @$info->outside1_country?>"/></td>
			</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date from(dd-mm-yyy)</td>
        	<td colspan="2"><input type="text" name="outside1_from" id="outside1_from" value="<?= @$info->outside1_from?>" style="width:80px"/> 
        		TO <input type="text" name="outside1_to" id="outside1_to" value="<?= @$info->outside1_to?>" style="width:80px"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>2</td>
        	<td class="even">Name</td>
        	<td colspan="2" class="even"><input type="text" name="outside2_name" value="<?= @$info->outside2_name?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Country(s)</td>
        	<td colspan="2" class="odd"><input type="text" name="outside2_country" value="<?= @$info->outside2_country?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Date from(dd-mm-yyy)</td>
        	<td colspan="2" class="even"><input type="text" name="outside2_from" id="outside2_from" value="<?= @$info->outside2_from?>" style="width:80px"/>
        		TO
        		<input type="text" name="outside2_to" id="outside2_to" value="<?= @$info->outside2_to?>" style="width:80px"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>3</td>
        	<td>Name</td>
        	<td colspan="2"><input type="text" name="outside3_name" value="<?= @$info->outside3_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country(s)</td>
        	<td colspan="2"><input type="text" name="outside3_country" value="<?= @$info->outside3_country?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date from(dd-mm-yyy)</td>
        	<td colspan="2"><input type="text" name="outside3_from" id="outside3_from" value="<?= @$info->outside3_from?>" style="width:80px"/>
        		TO
        		<input type="text" name="outside3_to" id="outside3_to" value="<?= @$info->outside3_to?>" style="width:80px"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">25 Do you, or any other person included in this application, intend to enter
            	a hospital or a health care facility (including nursing homes) while in
            	Australia?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_go_hospital" value="0" <?= (@$info->has_go_hospital==0)?'checked':''?> />No 
        	<input type="radio" name="has_go_hospital" value="1" <?= (@$info->has_go_hospital==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="go_hospital"><?= @$info->go_hospital?>
        	</textarea></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">26 Do you, or any other person included in this application, intend to work
            	as, or study to be, a doctor, dentist, nurse or paramedic during your
            	stay in Australia?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_go_work" value="0" <?= (@$info->has_go_work==0)?'checked':''?> />No 
        	<input type="radio" name="has_go_work" value="1" <?= (@$info->has_go_work==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="go_work"><?= @$info->go_work?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">27 Have you, or any other person included in this application:<br />
            	。ever had, or currently have, tuberculosis?<br />
            	。been in close contact with a family member that has active tuberculosis?<br />
            	。ever had a chest x-ray which showed an abnormality?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_tuberculosis" value="0" <?= (@$info->has_tuberculosis==0)?'checked':''?> />No 
        	<input type="radio" name="has_tuberculosis" value="1" <?= (@$info->has_tuberculosis==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="tuberculosis"><?= @$info->tuberculosis?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">28 During your proposed visit to Australia, do you, or any other person included in this application, expect to incur medical costs, or require treatment or medical follow up for:<br />
            	。blood disorder;<br />
            	。cancer;<br />
            	。heart disease;<br />
            	。hepatitis B or C and/or liver disease;<br />
            	。HIV infection, including AIDS;<br />
            	。kidney disease, including dialysis;<br />
            	。mental illness;<br />
            	。pregnancy;<br />
            	。respiratory disease that has required hospital admission or oxygen therapy;<br />
            	。other?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_treatment" value="0" <?= (@$info->has_treatment==0)?'checked':''?> />No 
        	<input type="radio" name="has_treatment" value="1" <?= (@$info->has_treatment==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="treatment"><?= @$info->treatment?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">29 Do you, or any other person included in this application, require assistance with mobility or care due to a medical condition?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_need_assistance" value="0" <?= (@$info->has_need_assistance==0)?'checked':''?> />No 
        	<input type="radio" name="has_need_assistance" value="1" <?= (@$info->has_need_assistance==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="need_assistance"><?= @$info->need_assistance?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">30 Have you, or any other person included in this application, ever:</td>
        	</tr>
        <tr class="even">
            <td colspan="4">。been convicted of a crime or offence in any country (including any conviction which is now removed from official records)?</td>
        	<td><input type="radio" name="is_field30_1" value="0" <?= (@$info->is_field30_1==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_1" value="1" <?= (@$info->is_field30_1==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">。been charged with any offence that is currently awaiting legal action?</td>
        	<td><input type="radio" name="is_field30_2" value="0" <?= (@$info->is_field30_2==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_2" value="1" <?= (@$info->is_field30_2==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">。been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?</td>
        	<td><input type="radio" name="is_field30_3" value="0" <?= (@$info->is_field30_3==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_3" value="1" <?= (@$info->is_field30_3==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">。been removed or deported from any country (including Australia)?</td>
        	<td><input type="radio" name="is_field30_4" value="0" <?= (@$info->is_field30_4==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_4" value="1" <?= (@$info->is_field30_4==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">。left any country to avoid being removed or deported?</td>
        	<td><input type="radio" name="is_field30_5" value="0" <?= (@$info->is_field30_5==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_5" value="1" <?= (@$info->is_field30_5==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">。been excluded from or asked to leave any country (including Australia)?</td>
        	<td><input type="radio" name="is_field30_6" value="0" <?= (@$info->is_field30_6==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_6" value="1" <?= (@$info->is_field30_6==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">。committed, or been involved in the commission of war crimes or crimes against humanity or human rights?</td>
        	<td><input type="radio" name="is_field30_7" value="0" <?= (@$info->is_field30_7==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_7" value="1" <?= (@$info->is_field30_7==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">。been involved in any activities that would represent a risk to Australian national security?</td>
        	<td><input type="radio" name="is_field30_8" value="0" <?= (@$info->is_field30_8==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_8" value="1" <?= (@$info->is_field30_8==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">。had any outstanding debts to the Australian Government or any public authority in Australia?</td>
        	<td><input type="radio" name="is_field30_9" value="0" <?= (@$info->is_field30_9==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_9" value="1" <?= (@$info->is_field30_9==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">。been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)?</td>
        	<td><input type="radio" name="is_field30_10" value="0" <?= (@$info->is_field30_10==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_10" value="1" <?= (@$info->is_field30_10==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">。served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)?</td>
        	<td><input type="radio" name="is_field30_11" value="0" <?= (@$info->is_field30_11==0)?'checked':''?> />No 
        	<input type="radio" name="is_field30_11" value="1" <?= (@$info->is_field30_11==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
		    <td>If you answered ‘Yes’ to any of the above questions, provide all the
relevant details. If insufficient space, attach an additional statement.</td>
            <td colspan="4"><textarea name="field30"><?= @$info->field30?></textarea></td>
        </tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part F – Employment status</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">31 What is your employment status?</td>
        	</tr>
		<tr class="odd">
            <td><input type="radio" name="employment_status" value="1" <?= (@$info->employment_status==1)?'checked':''?> />Employed/self-employed</td>
        	<td colspan="2" align="right">Name</td>
        	<td colspan="2"><input type="text" name="employed_name" value="<?= @$info->employed_name?>"/></td>
			</tr>
        <tr class="even">
            <td></td>
        	<td colspan="2" align="right">Address</td>
        	<td colspan="2"><input type="text" name="employed_address" value="<?= @$info->employed_address?>" style="width:250px"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="2" align="right">Telephone number</td>
        	<td colspan="2"><input type="text" name="employed_tel" value="<?= @$info->employed_tel?>"/></td>
			</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2" align="right">Position you hold</td>
        	<td colspan="2"><input type="text" name="employed_position" value="<?= @$info->employed_position?>"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="2" align="right">How long have you been employed by this employer/business?</td>
        	<td colspan="2">
			<input type="text" name="employed_year" value="<?= @$info->employed_year?>" style="width:20px"/>YEARS  
			<input type="text" name="employed_month" value="<?= @$info->employed_month?>" style="width:20px"/>MONTHS			</td>
			</tr>
        <tr class="even">
            <td><input type="radio" name="employment_status" value="2" <?= (@$info->employment_status==2)?'checked':''?> />Retired</td>
        	<td colspan="2" align="right">Year of retirement(dd-mm-yyyy)</td>
        	<td colspan="2"><input type="text" name="retire_date" id="retire_date" value="<?= @$info->retire_date?>"/></td>
			</tr>
		<tr class="odd">
            <td><input type="radio" name="employment_status" value="3" <?= (@$info->employment_status==3)?'checked':''?> />Student</td>
        	<td colspan="2" align="right">Your current course</td>
        	<td colspan="2"><input type="text" name="student_course" value="<?= @$info->student_course?>"/></td>
			</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2" align="right">Name of educational institution</td>
        	<td colspan="2"><input type="text" name="student_institution" value="<?= @$info->student_institution?>"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="2" align="right">How long have you been studying at this institution?</td>
        	<td colspan="2">
			<input type="text" name="student_year" value="<?= @$info->student_year?>" style="width:20px"/>YEARS 
			<input type="text" name="student_month" value="<?= @$info->student_month?>" style="width:20px"/>MONTHS			</td>
			</tr>
        <tr class="even">
            <td><input type="radio" name="employment_status" value="4" <?= (@$info->employment_status==4)?'checked':''?> />Other</td>
        	<td colspan="2" align="right">Please provide details</td>
        	<td colspan="2"><input type="text" name="other_detail" value="<?= @$info->other_detail?>"/></td>
			</tr>
		<tr class="odd">
            <td><input type="radio" name="employment_status" value="5" <?= (@$info->employment_status==5)?'checked':''?> />Unemployed</td>
        	<td colspan="2" align="right">Please provide details of your last
        		employment (if applicable)</td>
        	<td colspan="2"><textarea name="unemployed_detail" style="width:220px; height:40px"><?= @$info->unemployed_detail?></textarea></td>
			</tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part G – Evidence of funds</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">32 How will you be maintaining yourself financially while you are in Australia?</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4"><textarea name="maintain_detail"><?= @$info->maintain_detail?>
        	</textarea></td>
        	</tr>
        <tr class="even">
            <td colspan="5">33 Is someone else providing support for your visit to Australia?</td>
        	</tr>
		<tr class="odd">
            <td>
			<input type="radio" name="has_support" value="0" <?= (@$info->has_support==0)?'checked':''?> />No Go to Part H<br />
        	<input type="radio" name="has_support" value="1" <?= (@$info->has_support==1)?'checked':''?> />Yes Give details			</td>
        	<td>Full names</td>
        	<td>Relationship to you</td>
        	<td>Date of birth
        		<hr />
        		DAY MONTH YEAR</td>
			<td> Their address while you are in Australia</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="support1_name" value="<?= @$info->support1_name?>"/></td>
        	<td><input type="text" name="support1_relate" value="<?= @$info->support1_relate?>"/></td>
        	<td><input type="text" name="support1_birth" id="support1_birth" value="<?= @$info->support1_birth?>"/></td>
			<td><input type="text" name="support1_address" value="<?= @$info->support1_address?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="support2_name" value="<?= @$info->support2_name?>"/></td>
        	<td><input type="text" name="support2_relate" value="<?= @$info->support2_relate?>"/></td>
        	<td><input type="text" name="support2_birth" id="support2_birth" value="<?= @$info->support2_birth?>"/></td>
			<td><input type="text" name="support2_address" value="<?= @$info->support2_address?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="support3_name" value="<?= @$info->support3_name?>"/></td>
        	<td><input type="text" name="support3_relate" value="<?= @$info->support3_relate?>"/></td>
        	<td><input type="text" name="support3_birth" id="support3_birth" value="<?= @$info->support3_birth?>"/></td>
			<td><input type="text" name="support3_address" value="<?= @$info->support3_address?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="support4_name" value="<?= @$info->support4_name?>"/></td>
        	<td><input type="text" name="support4_relate" value="<?= @$info->support4_relate?>"/></td>
        	<td><input type="text" name="support4_birth" id="support4_birth" value="<?= @$info->support4_birth?>"/></td>
			<td><input type="text" name="support4_address" value="<?= @$info->support4_address?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="support5_name" value="<?= @$info->support5_name?>"/></td>
        	<td><input type="text" name="support5_relate" value="<?= @$info->support5_relate?>"/></td>
        	<td><input type="text" name="support5_birth" id="support5_birth" value="<?= @$info->support5_birth?>"/></td>
			<td><input type="text" name="support5_address" value="<?= @$info->support5_address?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">34 What support are they providing?</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="support_type" value="1" <?= (@$info->support_type==1)?'checked':''?> />Financial
        	<input type="radio" name="support_type" value="2" <?= (@$info->support_type==2)?'checked':''?> />Accommodation
			<input type="radio" name="support_type" value="3" <?= (@$info->support_type==3)?'checked':''?> />Other			</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part H – Previous applications</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">35 Have you, or any other person included in this application, ever:<br />
            	• been in Australia and not complied with visa conditions or departed Australia outside your authorised period of stay?<br />
            	• had an application for entry to or further stay in Australia refused, or had a visa for Australia cancelled?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="is_field35" value="0" <?= (@$info->is_field35==0)?'checked':''?> />No 
        	<input type="radio" name="is_field35" value="1" <?= (@$info->is_field35==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="field35"><?= @$info->field35?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">36 Complete the following details if you (or any other person included in this application)
            	have applied for permanent entry to Australia in the last 5 years</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Month and year(mm-yyyy)</td>
        	<td>Place of application</td>
        	<td>Type of visa applied for</td>
			<td>Was a visa granted? (YES or NO)</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="field36_1_date" value="<?= @$info->field36_1_date?>"/></td>
        	<td><input type="text" name="field36_1_place" value="<?= @$info->field36_1_place?>"/></td>
        	<td><input type="text" name="field36_1_type" value="<?= @$info->field36_1_type?>"/></td>
			<td>
			<input type="radio" name="field36_1_grant" value="NO" <?= (@$info->field36_1_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field36_1_grant" value="YES" <?= (@$info->field36_1_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="field36_2_date" value="<?= @$info->field36_2_date?>"/></td>
        	<td><input type="text" name="field36_2_place" value="<?= @$info->field36_2_place?>"/></td>
        	<td><input type="text" name="field36_2_type" value="<?= @$info->field36_2_type?>"/></td>
			<td>
			<input type="radio" name="field36_2_grant" value="NO" <?= (@$info->field36_2_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field36_2_grant" value="YES" <?= (@$info->field36_2_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="field36_3_date" value="<?= @$info->field36_3_date?>"/></td>
        	<td><input type="text" name="field36_3_place" value="<?= @$info->field36_3_place?>"/></td>
        	<td><input type="text" name="field36_3_type" value="<?= @$info->field36_3_type?>"/></td>
			<td>
			<input type="radio" name="field36_3_grant" value="NO" <?= (@$info->field36_3_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field36_3_grant" value="YES" <?= (@$info->field36_3_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="5">37 Complete the following details if you (or any other person included in this application)
            	have applied for temporary entry to Australia in the last 5 years</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Month and year(mm-yyyy)</td>
        	<td>Place of application</td>
        	<td>Type of visa applied for</td>
			<td>Was a visa granted? (YES or NO)</td>
        </tr>
        <tr class="even">
			<td>&nbsp;</td>
        	<td><input type="text" name="field37_1_date" value="<?= @$info->field37_1_date?>"/></td>
        	<td><input type="text" name="field37_1_place" value="<?= @$info->field37_1_place?>"/></td>
        	<td><input type="text" name="field37_1_type" value="<?= @$info->field37_1_type?>"/></td>
			<td>
			<input type="radio" name="field37_1_grant" value="NO" <?= (@$info->field37_1_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field37_1_grant" value="YES" <?= (@$info->field37_1_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td><input type="text" name="field37_2_date" value="<?= @$info->field37_2_date?>"/></td>
        	<td><input type="text" name="field37_2_place" value="<?= @$info->field37_2_place?>"/></td>
        	<td><input type="text" name="field37_2_type" value="<?= @$info->field37_2_type?>"/></td>
			<td>
			<input type="radio" name="field37_2_grant" value="NO" <?= (@$info->field37_2_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field37_2_grant" value="YES" <?= (@$info->field37_2_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td><input type="text" name="field37_3_date" value="<?= @$info->field37_3_date?>"/></td>
        	<td><input type="text" name="field37_3_place" value="<?= @$info->field37_3_place?>"/></td>
        	<td><input type="text" name="field37_3_type" value="<?= @$info->field37_3_type?>"/></td>
			<td>
			<input type="radio" name="field37_3_grant" value="NO" <?= (@$info->field37_3_grant=='NO')?'checked':''?> />No 
        	<input type="radio" name="field37_3_grant" value="YES" <?= (@$info->field37_3_grant=='YES')?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part I – Assistance with this form</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">38 Did you receive assistance in completing this form?</td>
        	</tr>
        <tr class="even">
            <td colspan="5">
			<input type="radio" name="is_assistance" value="0" <?= (@$info->is_assistance==0)?'checked':''?> />No Go to Part J 
        	<input type="radio" name="is_assistance" value="1" <?= (@$info->is_assistance==1)?'checked':''?> />Yes Please give details of the person who assisted you			</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">Title: 
			<input type="radio" name="assistance_title" value="1" <?= (@$info->assistance_title==1)?'checked':''?> />Mr 
        	<input type="radio" name="assistance_title" value="2" <?= (@$info->assistance_title==2)?'checked':''?> />Mrs 
			<input type="radio" name="assistance_title" value="3" <?= (@$info->assistance_title==3)?'checked':''?> />Miss 
        	<input type="radio" name="assistance_title" value="4" <?= (@$info->assistance_title==4)?'checked':''?> />Ms 
			Other<input type="text" name="assistance_title_other" value="<?= @$info->assistance_title_other?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Family name</td>
        	<td><input type="text" name="assistance_family_name" value="<?= @$info->assistance_family_name?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Given names</td>
        	<td><input type="text" name="assistance_given_name" value="<?= @$info->assistance_given_name?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Address</td>
        	<td colspan="2"><input type="text" name="assistance_address" value="<?= @$info->assistance_address?>" style="width:250px"/></td>
        	<td>POSTCODE
        		<input type="text" name="assistance_postcode" value="<?= @$info->assistance_postcode?>" style="width:50px"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Office hours</td>
        	<td colspan="3">COUNTRY CODE AREA CODE NUMBER<br />
			<input type="text" name="assistance_country" value="<?= @$info->assistance_country?>" style="width:30px"/>
			<input type="text" name="assistance_area" value="<?= @$info->assistance_area?>" style="width:30px"/>
			<input type="text" name="assistance_no" value="<?= @$info->assistance_no?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Mobile/cell</td>
        	<td colspan="3"><input type="text" name="assistance_tel" value="<?= @$info->assistance_tel?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="4">39 Is the person an agent registered with the Office of the Migration
            	Agents Registration Authority (Office of the MARA)?</td>
        	<td>
			<input type="radio" name="is_field39" value="0" <?= (@$info->is_field39==0)?'checked':''?> />No 
        	<input type="radio" name="is_field39" value="1" <?= (@$info->is_field39==1)?'checked':''?> />Yes Go to Part J			</td>
        </tr>
        <tr class="even">
            <td colspan="4">40 Is the person/agent in Australia?</td>
        	<td>
			<input type="radio" name="is_field40" value="0" <?= (@$info->is_field40==0)?'checked':''?> />No Go to Part J
        	<input type="radio" name="is_field40" value="1" <?= (@$info->is_field40==1)?'checked':''?> />Yes			</td>
        </tr>
		<tr class="odd">
            <td colspan="4">41 Did you pay the person/agent and/or give a gift for this assistance?</td>
        	<td>
			<input type="radio" name="is_field41" value="0" <?= (@$info->is_field41==0)?'checked':''?> />No 
        	<input type="radio" name="is_field41" value="1" <?= (@$info->is_field41==1)?'checked':''?> />Yes			</td>
        </tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part J – Options for receiving written communications</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">42 All written communications about this application should be sent to:
            	(Tick one box only)</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="field42" value="1" <?= (@$info->field42==1)?'checked':''?> />Myself 
        	<input type="radio" name="field42" value="2" <?= (@$info->field42==2)?'checked':''?> />Authorised recipient 
			<input type="radio" name="field42" value="3" <?= (@$info->field42==3)?'checked':''?> />Migration agent  
        	<input type="radio" name="field42" value="4" <?= (@$info->field42==4)?'checked':''?> />Agent exempt from registration			</td>
        	</tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part K – Payment details</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">43 How will you pay your application charge?</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="pay_type" value="1" <?= (@$info->pay_type==1)?'checked':''?> />Bank cheque 
        	<input type="radio" name="pay_type" value="2" <?= (@$info->pay_type==2)?'checked':''?> />Money order 
			<input type="radio" name="pay_type" value="3" <?= (@$info->pay_type==3)?'checked':''?> />Debit card (Cannot be used for applications lodged by mail) 
        	<input type="radio" name="pay_type" value="4" <?= (@$info->pay_type==4)?'checked':''?> />Credit card (Give details below)			</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Payment by (tick one box)</td>
        	<td colspan="3">
			<input type="radio" name="card_type" value="1" <?= (@$info->card_type==1)?'checked':''?> />MasterCard 
        	<input type="radio" name="card_type" value="2" <?= (@$info->card_type==2)?'checked':''?> />American Express 
			<input type="radio" name="card_type" value="3" <?= (@$info->card_type==3)?'checked':''?> />Visa 
        	<input type="radio" name="card_type" value="4" <?= (@$info->card_type==4)?'checked':''?> />Diners Club 
			<input type="radio" name="card_type" value="5" <?= (@$info->card_type==5)?'checked':''?> />JCB			</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Australian Dollars</td>
        	<td colspan="3"><input type="text" name="card_dollar" value="<?= @$info->card_dollar?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Credit card number</td>
        	<td colspan="3"><input type="text" name="card_no" value="<?= @$info->card_no?>" style="width:250px"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Expiry date</td>
        	<td colspan="3">MONTH<input type="text" name="card_expiry_month" value="<?= @$info->card_expiry_month?>" style="width:15px"/> / YEAR<input type="text" name="card_expiry_year" value="<?= @$info->card_expiry_year?>" style="width:30px"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Cardholder’s name</td>
        	<td colspan="3"><input type="text" name="cardholder_name" value="<?= @$info->cardholder_name?>"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Telephone number</td>
        	<td colspan="3">
			COUNTRY CODE AREA CODE NUMBER<br />
			<input type="text" name="cardholder_country" value="<?= @$info->cardholder_country?>" style="width:30px"/>
			<input type="text" name="cardholder_area" value="<?= @$info->cardholder_area?>" style="width:30px"/>
			<input type="text" name="cardholder_no" value="<?= @$info->cardholder_no?>"/>			</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Address</td>
        	<td colspan="2"><input type="text" name="cardholder_address" value="<?= @$info->cardholder_address?>" style="width:250px"/></td>
        	<td>POSTCODE
				<input type="text" name="cardholder_postcode" value="<?= @$info->cardholder_postcode?>" style="width:50px"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part L – Declaration and consent</strong></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Signature of DATE (dd-mm-yyyy) </td>
        	<td colspan="3"><input type="text" name="sign_date" id="sign_date" value="<?= @$info->sign_date?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
</form>

			</div>
		</div>
		
		<?=$this->load->view('include_sidebar',array('id'=>$id,'forms'=>$forms))?>
	</div>

<script type="text/javascript">
$().ready(function() {
  $("#form").validate({
    rules: {
		visit_from:"required",
		visit_to:"required",
		visit_stay:"required",
		is_more_enter:"required",
		sex:"required",
		family_name:"required",
		given_name:"required",
		marital_status:"required"
    }
  });
  
	$.datepicker.setDefaults(
		{
		dateFormat: 'dd-mm-yy',
		changeMonth: true,
		changeYear: true,
		showOn: "both",
		buttonImage: "images/calendar.gif",
		buttonImageOnly: true
		}
	);
	$("#visit_from").datepicker();
	$("#visit_to").datepicker();
	$("#birth").datepicker();
	$("#child1_birth").datepicker();
	$("#child2_birth").datepicker();
	$("#child3_birth").datepicker();
	$("#child4_birth").datepicker();
	$("#spouse1_birth").datepicker();
	$("#spouse2_birth").datepicker();
	$("#spouse3_birth").datepicker();
	$("#spouse4_birth").datepicker();
	$("#relatives1_birth").datepicker();
	$("#relatives2_birth").datepicker();
	$("#relatives3_birth").datepicker();
	$("#relatives4_birth").datepicker();
	$("#friend1_birth").datepicker();
	$("#friend2_birth").datepicker();
	$("#friend3_birth").datepicker();
	$("#friend4_birth").datepicker();
	$("#outside1_from").datepicker();
	$("#outside1_to").datepicker();
	$("#outside2_from").datepicker();
	$("#outside2_to").datepicker();
	$("#outside3_from").datepicker();
	$("#outside3_to").datepicker();
	$("#retire_date").datepicker();
	$("#support1_birth").datepicker();
	$("#support2_birth").datepicker();
	$("#support3_birth").datepicker();
	$("#support4_birth").datepicker();
	$("#support5_birth").datepicker();
	$("#sign_date").datepicker();
	
	$("#email").autoMail();
	
	$("#printInfo").click(function(o) {
		var prints = [
			{rel_id: <?=$cateid?>, rec_id: <?=$id?>}
		]  ;
		
		var jdata = JSON.stringify(prints);
		//alert(jdata);
		$.post("<?=site_url('proxy/does/'.str_replace('==','',base64_encode('http://'.$_SERVER['SERVER_NAME'].':9090/javaprduct/servlet/test')))?>",{clients:jdata},function(msg){alert(msg)});
	});
	
	$("#printInfo").ajaxError(function(event,request, settings){
		//$(this).append("<li>出错页面:" + settings.url + "</li>");
		alert("无法访问"+ settings.url );
	}); 
 
});
</script>

<?=$this->load->view('include_footer',null)?>